ATI RN
ATI RN Mental Health 2023 Questions
Extract:
Question 1 of 5
A nurse has placed a client who has become physically aggressive into seclusion. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Document the client's behavior every 15 min. This is crucial for monitoring the client's condition and assessing the effectiveness of seclusion. Documenting every 15 minutes allows the nurse to track changes in behavior, ensure safety, and provide necessary interventions promptly. Obtaining the provider's prescription within 60 minutes (
B) is important but not as immediate as documenting behavior. Monitoring vital signs (
C) is essential but should be done more frequently for a physically aggressive client in seclusion. Offering food and fluids (
D) is not a priority in this situation.
Question 2 of 5
A nurse is assisting with obtaining informed consent for a client who has been declared legally incompetent. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Request that the client's guardian sign the consent. In cases where a client has been declared legally incompetent, a guardian is legally responsible for making decisions on their behalf. This ensures that the client's best interests are considered and that the consent is valid. Asking the guardian to sign the consent is the appropriate action to take in this situation.
A: Explaining implied consent to the client's family is not sufficient as the client's legal guardian should be involved in decision-making for an incompetent client.
B: Asking the charge nurse to obtain informed consent may not be appropriate as the client's guardian should be the one making the decision.
C: While contacting the facility social worker may be helpful, it is ultimately the guardian's responsibility to provide consent for the incompetent client.
D: Requesting the client's guardian to sign the consent is the correct course of action in this scenario.
Question 3 of 5
A nurse is caring for a client who reports that he is angry with his partner because she thinks he is just trying to gain attention. When the nurse attempts to talk to the client, he becomes angry and tells her to leave. Which of the following defense mechanisms is the client demonstrating?
Correct Answer: A
Rationale: The correct answer is A: Displacement. Displacement is a defense mechanism where emotions are redirected from the original source to a less threatening target. In this scenario, the client is angry with his partner but instead directs his anger towards the nurse, asking her to leave. This behavior of displacing his anger onto the nurse demonstrates the defense mechanism of displacement.
Choice B: Compensation involves overachieving in one area to make up for a perceived deficiency in another area, which is not demonstrated in this scenario.
Choice C: Denial is refusing to acknowledge reality, which is not evident as the client acknowledges his anger.
Choice D: Rationalization involves creating logical explanations to justify unacceptable behavior, which is not happening here.
Question 4 of 5
A nurse is caring for a client who has a binge eating disorder. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Plan a menu with the client. This is important because involving the client in meal planning empowers them to make healthier food choices and develop a structured eating routine, which can help in managing binge eating disorder. Weighing the client every other day (
Choice
A) may exacerbate anxiety and reinforce unhealthy focus on weight. Remaining with the client for 1 hr after meals (
Choice
B) may not address the root causes of binge eating. Offering snacks when the client is hungry (
Choice
C) may not address the underlying issues of the disorder and could potentially encourage unhealthy eating behaviors.
Question 5 of 5
A nurse is providing behavioral therapy for a client who has obsessive-compulsive disorder. The client repeatedly checks that the doors are locked at night. Which of the following instructions should the nurse give the client when using thought stopping technique?
Correct Answer: D
Rationale: The correct answer is D: Snap a rubber band on your wrist when you think about checking the locks. This technique is a form of aversion therapy, which helps the client interrupt the obsessive thought pattern by associating it with a negative physical sensation. By snapping the rubber band on the wrist, the client creates a negative consequence for the behavior, making it less desirable to continue the checking behavior. This helps in breaking the cycle of obsessive thoughts and compulsive behaviors associated with obsessive-compulsive disorder.
A: Asking a family member to check the locks enables avoidance rather than addressing the underlying issue.
B: Keeping a journal may help increase awareness but does not actively interrupt the thought pattern.
C: Focusing on abdominal breathing is a relaxation technique that may help manage anxiety but does not directly address the obsessive behavior.
E, F, G: These options are not provided in the question and are therefore irrelevant.